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BMJ Open. 2025 May 24;15(5):e101417. doi: 10.1136/bmjopen-2025-101417.

ABSTRACT

BACKGROUND: Aortic valve stenosis (AVS) represents the most prevalent primary valvular lesion necessitating surgical intervention or transcatheter intervention in Europe and North America. Its prevalence is increasing at a rapid rate as a consequence of the ageing population. A variety of mechanical interventions are available to determine the management of AVS; however, there is currently a paucity of robust data with which to perform a comparative analysis of the efficacy of surgical aortic valve replacement (SAVR) and that of conventional stented xenograft bioprostheses (BP) or sutureless aortic valves (SAV) and transcatheter aortic valve implantation (TAVI). The present study aims to compare the effectiveness and clinical outcomes of SAVR using BP or SAV technique and TAVI in patients with severe AVS.

METHODS AND ANALYSIS: A collaboration between three cardiac surgery centres across two European countries has resulted in the conception of the Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement trial. This prospective non-randomised trial is designed to evaluate the long-term outcomes of TAVI in comparison to SAVR for AVS in patients at risk of severe valve obstruction. The registry will enrol successive patients who have undergone mechanical intervention for AVS between January 2015 and December 2025. Investigators will assess the difference between replacement procedures for both the standard surgical approach and the transcatheter procedure. The principal clinical outcome under consideration will be the composite degree of all-cause mortality, ischaemic stroke or rehospitalisation at 10 years. The present study will also have a number of secondary endpoints, including all-cause mortality, followed by functional status, hospitalisation, neurocognition, physiological measures (echocardiographic assessment), adverse events and reoperation.

ETHICS AND DISSEMINATION: It is hypothesised that the nature of the trials will serve to minimise bias related to institutional volume and surgical experience. Each participating centre is required to have an aortic valve programme that enables proper follow-up and management of any late aortic events following replacement surgery for the AVS. The data collected will provide valuable insight into the comparative effectiveness of various surgical approaches, both standardised and advanced, in aortic valve surgery and TAVI. This comprehensive analysis will contribute significantly to the development of robust international guidelines.

TRIAL REGISTRATION NUMBER: Clinical Trial Gov.Com. ID: NCT05261204 IRB. ID: 2022011057.

PMID:40413055 | PMC:PMC12104930 | DOI:10.1136/bmjopen-2025-101417

Biomaterials. 2025 Dec;323:123418. doi: 10.1016/j.biomaterials.2025.123418. Epub 2025 May 20.

ABSTRACT

Novel cardiac patch designs achieved by advanced 3D manufacturing continue to have favorable impacts on the repair and regeneration of the myocardium after injury. Briefly, auxetic units with a negative Poisson's ratio have already shown remarkable promise for serving as a next-generation complex scaffold in left ventricular disease. In this study we biofabricated a 3D printed polycaprolactone (PCL) cardiac auxetic patch loaded with high density contractile induced pluripotent stem cell-derived cardiomyocytes (iCMs) and examined the synergist effect of iCM auxetic patches on a chronic myocardial infarct rodent model compared to a stiffer non-auxetic control patch architecture. A week after the induction of a temporary left anterior descending artery ligation, we administered the treatment groups in the form of patch implantation over the ischemic area after initial acute inflammation was complete and prior to granulation tissue formation following the infarct for clinical relevance. Our findings highlight that auxetic patches can provide additional ventricular support and diminished adverse ventricular remodeling, as seen through ejection fraction outputs and histology, and iCM-laden auxetics show localized regenerative potential through increased vascularization compared to controls with no patch or a non-auxetic patch architecture. Exploration on the impact of a negative Poisson's ratio on both global functional outcomes and local therapeutic benefit highlights that iCM-laden auxetics should be further surveyed for other cardiac pathophysiologic conditions, including more in-depth studies on infarction or right ventricular disease.

PMID:40408975 | DOI:10.1016/j.biomaterials.2025.123418

Sci Adv. 2025 May 23;11(21):eadt9446. doi: 10.1126/sciadv.adt9446. Epub 2025 May 23.

ABSTRACT

The adult mammalian heart has limited regenerative capacity due to the low proliferative ability of cardiomyocytes, whereas embryonic cardiomyocytes exhibit robust proliferative potential. Using single-cell RNA sequencing of embryonic hearts, we identified prothymosin α (PTMA) as a key factor driving cardiomyocyte proliferation. Overexpression of PTMA in primary mouse and rat cardiomyocytes significantly promoted cardiomyocyte proliferation and similarly enhanced proliferation in human iPSC-derived cardiomyocytes. Conditional knockout of Ptma in cardiomyocytes impaired neonatal heart regeneration. AAV9-mediated overexpression of Ptma extended the neonatal proliferative window and showed therapeutic promise for enhancing adult heart regeneration. Mechanistically, PTMA interacted with MBD3, inhibiting its deacetylation activity within the MBD3/HDAC1 NuRD complex. This inhibition increased STAT3 acetylation, which positively regulated STAT3 phosphorylation and activation of its target genes. These findings establish PTMA as a critical regulator of heart regeneration and suggest its potential as a therapeutic target for ischemic myocardial injury.

PMID:40408476 | PMC:PMC12101487 | DOI:10.1126/sciadv.adt9446

J Am Coll Radiol. 2025 May;22(5S):S67-S78. doi: 10.1016/j.jacr.2025.02.038.

ABSTRACT

Cardiac risk stratification is clinically useful prior to initiation of oncologic therapy in asymptomatic patients in order to guide treatment decisions and allow for initiation of cardioprotective therapy or modification of treatment regimens. Once oncology treatment is underway, patients may develop cardiac symptoms. In this setting, imaging can be used for assessment of ventricular and valvular function, myocardial characterization, pericardial effusion or constriction, as well as to evaluate for ischemia as a cause of symptoms. Results can help guide treatment choices and shared decision-making regarding modification or cessation of treatments with associated cardiotoxicity. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

PMID:40409896 | DOI:10.1016/j.jacr.2025.02.038

JACC Case Rep. 2025 May 21;30(11):103312. doi: 10.1016/j.jaccas.2025.103312. Epub 2025 Apr 9.

ABSTRACT

Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension and valvular heart disease. The accurate assessment of RV function is however limited by the presence of concomitant tricuspid regurgitation (TR). Implantation of a novel transcatheter tricuspid valve device in this case highlights the importance of recognizing these limitations, and the need to define alternative ways to measure RV systolic function, contextualized to pulmonary pressure in patients with severe TR. It also demonstrates the clinical potential of perforation of the pop-off zone in this prosthesis, to create mild residual TR, thereby reducing the increase in RV afterload of this intervention, and its impact on RV systolic function.

PMID:40409857 | DOI:10.1016/j.jaccas.2025.103312

Neurol India. 2025 May 1;73(3):480-487. doi: 10.4103/neurol-india.Neurol-India-D-24-00199. Epub 2025 May 23.

ABSTRACT

INTRODUCTION: Therapeutic large-volume plasmapheresis (LVP) effectively manages neurological diseases, such as Guillain-Barre syndrome (GBS) and myasthenia gravis (MG), but it induces alterations in intravascular volume, necessitating vigilant monitoring. This study investigated the hemodynamic changes and the utility of non-invasive cardiac output monitoring (NICOM) during LVP.

METHODS: This prospective observational study included 50 neurological patients receiving their first LVP cycle. Standard monitoring of heart rate (HR), non-invasive blood pressure (NIBP), pulse oximetry (SpO2), and cardiac output (CO) using NICOM was performed. Changes in HR, NIBP, CO, total peripheral resistance (TPR), stroke volume (SV), and stroke volume variation (SVV) were recorded at baseline and multiple time points during LVP.

RESULTS: The mean age was 36 ± 15.05 years. The mean arterial pressure (MAP) significantly decreased from baseline at 30 and 60 minutes, and LVP completion (P < 0.05). While HR and systolic/diastolic blood pressure (SBP/DBP) remained stable, SV, CO, and cardiac index (CI) significantly decreased (P < 0.05), peaking at 60 minutes. TPR significantly increased (P < 0.05) with a maximum of 30 minutes. The volume of plasma removed directly influenced CO, CI, and SV changes (P < 0.05).

DISCUSSION: LVP induced transient hemodynamic alterations, primarily affecting CO and TPR. Despite fluid replacement, significant changes occurred, highlighting the need for close CO monitoring, especially in GBS patients with potential autonomic dysfunction.

CONCLUSION: LVP significantly alters hemodynamics, impacting CO and TPR. Standard monitoring might miss these changes, emphasizing the importance of NICOM, particularly in neurological patients. Further research is warranted to solidify NICOM's role in optimizing LVP protocols and improving patient outcomes.

PMID:40408575 | DOI:10.4103/neurol-india.Neurol-India-D-24-00199

Dimens Crit Care Nurs. 2025 Jul-Aug 01;44(4):181-185. doi: 10.1097/DCC.0000000000000701.

ABSTRACT

Cardiogenic shock poses a significant challenge in health care, with high mortality rates despite advancements in treatment. This case report details the management of a severe cardiogenic shock using venoarterial extracorporeal membrane oxygenation and an Impella CP device (Abiomed Inc, Danvers, Massachusetts), collectively referred to as ECPELLA, with a focus on nursing interventions. A 31-year-old man presented with acute myocarditis-induced cardiogenic shock. Initial assessment revealed severe biventricular dysfunction and respiratory failure requiring double mechanical support with ECPELLA, combined with continuous inotropic therapy and antibiotics. Mechanical support stabilized hemodynamics, allowing for cardiac and respiratory weaning. After 6 days, the patient showed significant improvement, permitting device removal and discharge after 9 days without complications. Managing cardiogenic shock patients with dual mechanical support demands vigilant nursing care to mitigate risks of complications such as pressure injuries, infections, and limb ischemia. Nursing care included meticulous monitoring, maintenance of assistive devices, and a series of specific interventions encompassing skin care, infection prevention, limb assessment, nutritional support, and vital parameter monitoring. Continuous monitoring and adherence to protocols are crucial. The successful management of cardiogenic shock with ECPELLA requires a multidisciplinary approach and specialized nursing care. Further research is needed to establish best practices and improve outcomes in these complex cases.

PMID:40408172 | DOI:10.1097/DCC.0000000000000701

Med Sci (Basel). 2025 May 12;13(2):60. doi: 10.3390/medsci13020060.

ABSTRACT

BACKGROUND: Aim of the study is to analyze the trends and outcomes in Left Ventricular Assist Device (LVAD) placements between the years 2016 and 2022 using the National Inpatient Sample (NIS).

METHODS: Using the NIS for the years 2016-2022, we identified the total number of LVAD placements using the PCS 10 code 02HA0QZ. In-hospital outcomes and healthcare resource utilization burden were assessed. Stratification of outcomes with Extracorporeal Membrane Oxygenation (ECMO) support were performed for the years 2018-2022. Outcome analysis variance in admissions requiring ECMO support was performed using multivariate regression analysis. A two tailed p-value < 0.05 was used to determine statistical significance.

RESULTS: A general decreasing trend was observed in the total number of LVAD placements, with 852 total admissions requiring LVAD placements identified in 2016 compared to 665 in 2022. The admissions for LVAD placements requiring ECMO support had an increasing trend, with 2.21% of admissions needing ECMO support in 2018 compared to 12.18% in 2018. After multivariate regression analysis, the association between all-cause mortality during the hospital stay for LVAD placements and requirement of ECMO was found to be significant, with an odds ratio of 2.34 (1.83-4.42, p-value: 0.001).

CONCLUSIONS: A general decreasing trend in LVAD placements was observed between 2016 and 2022. All-cause mortality and hospital charges during the admission had a stable trend over the years. The requirement of ECMO support had an increasing trend from 2018 to 2022. Requirement of ECMO support during the admissions for LVAD placements had a statistically significant association with all-cause mortality during the admission. A 11.50% readmission rate was observed in the 30 days following discharge, with heart failure being the major cause of readmission.

PMID:40407555 | PMC:PMC12101218 | DOI:10.3390/medsci13020060

Br J Hosp Med (Lond). 2025 May 23;86(5):1-15. doi: 10.12968/hmed.2024.0928. Epub 2025 May 22.

ABSTRACT

Aims/Background Uremia is a severe manifestation of end-stage renal failure, with high cardiovascular risk, and current dialysis treatments like hemodialysis (HD) face limitations in toxin clearance, necessitating more effective therapeutic strategies. This study aims to evaluate the clinical efficacy of HD combined with hemodiafiltration (HDF) in treating uremia and its influence on cardiac ultrasound indices. Methods This study retrospectively analyzed clinical data from 80 uremic patients treated at the Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University between April 2019 and April 2023. Based on different therapeutic regimens, patients were divided into a control group (n = 41) and an observation group (n = 39). The control group received HD, while the observation group underwent HD combined with HDF. The cardiac structure, cardiac function, lipid metabolism, and other biochemical indicators were comparatively assessed between the two groups. Results There were no significant differences in baseline characteristics between the two groups (p > 0.05). Before treatment, both groups demonstrated no significant difference in left atrial diameter (LAD), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), brain natriuretic peptide (BNP), and troponin T (TnT) (p > 0.05). However, after 6 months of treatment, these indices were significantly declined in the observation group (p < 0.05). Similarly, no significant differences were observed in left ventricular ejection fraction (LVEF), fractional shortening (FS), cardiac output (CO), stroke volume (SV), and peak mitral E-wave velocity/peak mitral A-wave velocity (E/A) before treatment (p > 0.05). However, a significant improvement was observed in the observation group following 6 months of treatment (p < 0.05). Before treatment, there were no significant differences in serum creatinine (Scr), blood urea nitrogen (BUN), β2-microglobulin (β2-MG), and parathyroid hormone (PTH) between the two groups (p > 0.05). However, the observation group showed significant improvements in Scr, BUN, β2-MG, and PTH after treatment (p < 0.001). Additionally, the two study groups had no significant differences in total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) before treatment (p > 0.05). However, their levels decreased significantly in the observation group after treatment (p < 0.05). Hypertension and hypotension occurred less frequently in the observation group (p < 0.05), with no significant differences observed in the incidence of arrhythmia and infection between the two groups (p > 0.05). Conclusion HD combined with HDF effectively improves cardiac structure and function, reduces metabolic wastes such as Scr, BUN and β2-MG, and decreases blood lipid levels in uremic patients. This study further confirmed the clinical efficacy of this combined approach in treating uremia, which is of positive significance for the prevention and treatment of cardiovascular diseases in uremic patients.

PMID:40405851 | DOI:10.12968/hmed.2024.0928

Circ Heart Fail. 2025 May 22:e012489. doi: 10.1161/CIRCHEARTFAILURE.124.012489. Online ahead of print.

ABSTRACT

Recent findings emphasize the potential role of invasive hemodynamic assessment in guiding transcatheter mitral and tricuspid valve percutaneous interventions. Right heart catheterization-derived parameters offer insights into hemodynamic changes associated with valvular heart diseases, pulmonary hypertension phenotyping, and right ventricular to pulmonary artery coupling. This might improve prognostic stratification for candidates to transcatheter therapies. This review provides a clinical overview of available data regarding the utility of preoperative right heart catheterization-derived parameters in patients undergoing mitral and tricuspid percutaneous repair or replacement.

PMID:40401405 | DOI:10.1161/CIRCHEARTFAILURE.124.012489

Cardiol J. 2025 May 22. doi: 10.5603/cj.104429. Online ahead of print.

NO ABSTRACT

PMID:40401360 | DOI:10.5603/cj.104429

Thorac Cardiovasc Surg. 2025 Jun 10. doi: 10.1055/a-2618-4744. Online ahead of print.

ABSTRACT

After cardiac surgery, long aortic clamping times and extracorporeal circulation times are associated with worse outcomes. This study compares hemodynamic performance, myocardial metabolism, and ultrastructural preservation in rat hearts after applying esmolol crystalloid cardioplegia (ECCP) or Calafiore blood cardioplegia (Cala).Hearts from 18 Wistar rats were perfused in a Langendorff system. Following 120 minutes of ischemia at 36 °C, hearts received either ECCP at 32 °C for 3 minutes or Cala at 36 °C for 2 minutes every 20 minutes. During 90 minutes of reperfusion, coronary blood flow (CF), left ventricular developed pressure (LVDP), and contraction/relaxation velocities (±dp/dt) were recorded. Myocardial oxygen consumption, lactate production, and troponin I levels were measured. Electron microscopy was used for ultrastructural assessment.Baseline (BL) values of LVDP, CF, and ±dp/dt were similar between the two groups. After 90 minutes of reperfusion, CF was significantly higher in the ECCP group: 85 ± 43% of BL in the ECCP group versus 42 ± 24% of BL in the Cala group (p = 0.002). At the end of reperfusion, hearts exposed to ECCP had higher LVDP (91 ± 40%) values than Cala (43 ± 10%), indicating improved cardiac recovery with ECCP. Myocardial contraction and relaxation were notably better in the ECCP group: dLVP/dtmax was 111 ± 40% versus 59 ± 13% in the Cala group (p = 0.002), and dLVP/dtmin was 88 ± 34% versus 40 ± 7% (p = 0.001). Troponin I levels measured in Cala hearts at the end of reperfusion were higher than in ECCP hearts (Cala 1,102.6 ± 361.3 ng/mL vs. ECCP 442.3 ± 788.4 ng/mL, p = 0.036).In rat hearts, ECCP offers better hemodynamic recovery and protects the myocardium from ischemia/reperfusion-related damage, better than Cala blood cardioplegia, even with aortic clamping times of 120 minutes.

PMID:40404136 | DOI:10.1055/a-2618-4744

JACC Asia. 2025 May 3:S2772-3747(25)00224-8. doi: 10.1016/j.jacasi.2025.03.011. Online ahead of print.

ABSTRACT

Valvular heart disease poses a significant health burden in the Asia-Pacific region, with its epidemiology varying widely across countries caused by diverse socioeconomic and health care situations. Rheumatic heart disease remains prevalent, especially in low- to middle-income areas, while degenerative valvular diseases are emerging in developed regions caused by an aging population. Significant disparities in access to health care and intervention result in variable clinical outcomes. In the past decade, transcatheter interventions have revolutionized the management of patients with valvular heart disease globally. In the Asia-Pacific region, the uptake and development of transcatheter valvular interventions has been slow until recent years. Continued collaboration across the Asia-Pacific region is essential to mitigate the impact of the upcoming surge of valvular heart disease in this diverse and rapidly changing area.

PMID:40396937 | DOI:10.1016/j.jacasi.2025.03.011

Macromol Biosci. 2025 May 20:e70007. doi: 10.1002/mabi.202400578. Online ahead of print.

ABSTRACT

Following myocardial infarction (MI), progressive death of cardiomyocytes and subsequent loss of the extracellular matrix leads to drastic alterations in the structure and mechanical performance of the heart, thereby leading to infarct expansion and cardiac dysfunction. To compensate for the lack of reparative potency in infarcted hearts and to inhibit negative remodeling in the myocardium after MI, stem cell-based therapy in combination with hydrogels has emerged as a promising strategy to improve cardiac function recovery. In this study, a novel injectable hydrogel derived from decellularized Wharton's jelly extracellular matrix (DWJM) is prepared and examined the therapeutic performance of a combination of bioactive DWJM hydrogels and Wharton's jelly mesenchymal stem cells (WJMSCs) for myocardial repair in ischemic rats. In vitro examinations indicated that the DWJM hydrogel exhibited appropriate rheological performance and is capable of undergoing sol-gel transition at 37 °C. After intramyocardial injection in MI rats, DWJM-trapped WJMSCs significantly improved cardiac function recovery, reduced scar formation, and promoted cardiomyogenesis and microvascular renewal compared to WJMSCs or DWJM hydrogels alone. The results demonstrated that the DWJM hydrogel and WJMSCs synergistically promoted myocardial repair, which further confirmed the promising stem cell therapy using the bioactive ECM hydrogel.

PMID:40391578 | DOI:10.1002/mabi.202400578

Circ Arrhythm Electrophysiol. 2025 Jun;18(6):e013684. doi: 10.1161/CIRCEP.124.013684. Epub 2025 May 20.

ABSTRACT

BACKGROUND: Stereotactic arrhythmia radiotherapy (STAR) has emerged as a potential therapy for treatment-refractory ventricular tachycardia (VT). However, the mechanisms underlying STAR efficacy, such as scar or other electromechanical changes, are still unclear. The goal of this study was to develop a translational porcine model of ischemic monomorphic VT treated with STAR to examine the physiological changes after a typical clinical STAR treatment.

METHODS: We treated a previously validated porcine model of monomorphic VT after myocardial infarction with a clinically derived STAR protocol. A dose of 25 Gy was prescribed to the planning target volume and 35 Gy to the clinical target volume (regions of scar), while controls underwent a sham STAR treatment. All investigators in the study were blinded except the treating investigator. The primary study outcome was VT inducibility at 6 weeks post-STAR. Animals underwent pre- and post-STAR cardiac magnetic resonance imaging to quantify myocardial scar and function, as well as body surface mapping. Six weeks post-STAR, animals underwent a VT induction study, and tissue was harvested for optical mapping and histological analysis.

RESULTS: Six animals completed the study, which ended before finishing enrollment because all animals had inducible VT. We found a significantly longer local effective refractory period in the left ventricular apex and longer VT cycle lengths in STAR-treated animals compared with controls (P<0.05). We found no difference in myocardial scar burden, mechanical function, or body surface recordings when comparing pre- and post-STAR.

CONCLUSIONS: Our data suggest a novel therapeutic mechanism of STAR driven by increasing the effective refractory period in locally treated areas, corresponding to increased tissue wavelength. Our results corroborate clinical case reports and anecdotal evidence that STAR increases VT cycle length. Importantly, these effects were not mediated by an increase in myocardial scar burden. However, our studies do not examine the long-term effects of STAR.

PMID:40391432 | PMC:PMC12173950 | DOI:10.1161/CIRCEP.124.013684

Perfusion. 2025 May 20:2676591251344859. doi: 10.1177/02676591251344859. Online ahead of print.

ABSTRACT

IntroductionCardiopulmonary bypass (CPB) is essential for cardiac surgery but poses risks, including gaseous micro emboli (GME). While the incidence of stroke-a common clinical consequence of embolism-ranges from 1-5% in cardiac surgery, prevalence of GME during CPB remain poorly understood.ObjectivesTo quantitatively compare GME incidence in the arterial line between cavoatrial and bicaval cannulation during open-heart surgery. Secondary exploratory objectives include evaluating the impact of venous reservoir volume on GME, and the correlation between GME in the venous and arterial lines.MethodsThis single center randomized controlled trial was conducted at Sahlgrenska University Hospital, Sweden. Patients ≥18 years undergoing planned aortic valve repair/replacement with cavoatrial cannulation, or mitral valve repair/replacement with bicaval cannulation, with or without coronary artery revascularization, were screened for eligibility. Patients were further randomized to either venous reservoir volume of ≥300 mL (control) or 200-300mL (intervention). GME detection was performed using GAMPT BCC300 with probes positioned at multiple locations within the CPB circuit.Results39 patients were included. No significant differences in GME quantity in the arterial line were observed between the cannulation methods (count p=.444; volume p=967). Similarly, no significant differences were found based on venous reservoir volume (count p=.074; volume p=.166). Furthermore, no significant correlation was observed between GME in venous line entering the arterial line (count p-value=492; volume p-value=.750). The CPB circuit effectively removed 99.14% of GME, with no adverse events reported.ConclusionNo significant differences were found in arterial GME count or volume between cavoatrial and bicaval cannulation during CPB. These findings underscore the importance of the bypass circuit's air-handling capacity, as well as the role of modern oxygenators and arterial line filters in effectively minimizing the passage of GME. Trial Registration:ClinicalTrials.gov Identifier: NCT05820828URL: https://clinicaltrials.gov/ct2/show/NCT05820828.

PMID:40393695 | DOI:10.1177/02676591251344859

Thorac Cardiovasc Surg. 2025 Jun 5. doi: 10.1055/a-2616-4962. Online ahead of print.

ABSTRACT

Sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) are nephroprotective in patients with recompensated acute and chronic heart failure (HF) and chronic kidney disease, but their potential influence during cardiac surgery is unclear. Currently, discontinuation of SGLT2i at least 2 days before surgery is recommended.Between March 2022 and December 2023, 53 cardiac surgical patients on SGLT2i therapy in addition to standard medical treatment for HF were compared with 447 other HF patients from the same period. After 1:1 covariate adjustment, 33 patients with SGLT2i treatment were matched with 33 controls. The primary endpoint was a change in estimated glomerular filtration rate (eGFR) 36 hours after surgery. Secondary endpoints were changes in eGFR, cumulative urine output, diuretic efficacy, and albuminuria over seven postoperative days.Mean baseline eGFR was similar between the groups (p = 0.973). Thirty-six hours postoperatively, eGFR was significantly higher in the SGLT2i group by a mean difference (MD) of 11.8 mL/min (95% CI [3.12-20.44]; p = 0.009) compared with the control group. The mean urinary albumin level was 18.1 mg/mL lower in the SGLT2i group (95% CI [-42.5-6.33]; p = 0.143). There were numerically positive changes in urine output and diuretic efficacy in the SGLT2i group without significant difference: MD 131.4 mL/24 hours (95% CI [-366.7-629.5]; p = 0.600) and MD 11.3 mL/mg (95% CI [-12.2-34.7]; p = 0.301), respectively, although the dosage of diuretics was higher in controls (30.6 ± 43.7 vs. 51.3 ± 130.1 mg/24 hours; p = 0.268, respectively).SGLT2i may have nephroprotective effects in patients undergoing heart surgery with extracorporeal circulation. More evidence is needed to determine whether SGTL2i needs to be discontinued before surgery.

PMID:40393690 | DOI:10.1055/a-2616-4962

Circ Heart Fail. 2025 May 20. doi: 10.1161/CIRCHEARTFAILURE.124.012702. Online ahead of print.

ABSTRACT

Background: The sex-related prognosis of patients with cardiogenic shock (CS) undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remains unclear. Our analyses aim to assess sex-specific outcomes in patients with CS receiving VA-ECMO and explored whether the effect of moderate hypothermia (MH) on clinical outcomes was modified by sex. Methods: In this post-hoc analysis of the HYPO-ECMO trial, clinical outcomes were compared by sex. The primary outcome was 30-day all-cause mortality (ACM). Key secondary outcomes included ACM and a composite outcome of ACM, heart transplant, escalation to left ventricular assist device implantation, or stroke at 30, 60 and 180 days. Results: Among the 334 patients enrolled in the trial, 81 (24%) were female. At 30 days, 45.7% of female and 46.6% of male patients experienced the primary outcome, with no sex differences (adjusted OR, 1.01 [0.57 - 1.78], p=0.98 and log-rank test, p=0.93). No significant sex differences were observed in all-cause mortality at 60 and 180 days (adjusted OR, 0.87 [0.49 - 1.52], p=0.61 and 0.83 [0.47 - 1.46], p=0.51, respectively) or in the composite outcome up to 180 days (p>0.2 for all). The effect of MH on the primary outcome (aOR, 0.73 [0.43 - 1.25], p=0.25 and 0.67 [0.26 - 1.76], p=0.41, in male and female respectively, interaction p-value = 0.88) and secondary outcomes (interaction p-value >0.3 for all) was not modified by sex. Conclusions: In this post-hoc analysis of the HYPO-ECMO trial, male and female experienced similar outcomes in CS treated with VA-ECMO. Sex did not significantly modify the effect of moderate hypothermia on outcomes. Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02754193.

PMID:40390595 | DOI:10.1161/CIRCHEARTFAILURE.124.012702

Stem Cell Res Ther. 2025 May 19;16(1):247. doi: 10.1186/s13287-025-04363-w.

ABSTRACT

Cardiovascular diseases are the main cause of death and disability in the clinical setting. Among several pathological conditions, myocardial infarction (MI) is a common clinical finding and happens due to the reduction or complete interruption of blood support. Stem cells and progenitors are valid cell sources with significant potential to alleviate several tissue injuries. Differentiation to mature and functional cells and the release of various growth factors, and cytokines are the main reparative mechanisms by which stem cells mediate their reparative tasks. Exosomes (Exos), a subset of extracellular vesicles (EVs), exhibit great theranostic potential in biomedicine. Along with whole-cell-based therapies, the pre-clinical and clinical application of Exos has been extended in animals and humans with ischemic heart diseases (IHD). Here, in this review article, we aimed to highlight the importance of Exos in IHD and address the mechanism of action by focusing on their regenerative potential.

PMID:40390086 | PMC:PMC12090443 | DOI:10.1186/s13287-025-04363-w

Comput Biol Med. 2025 Jun;192(Pt B):110398. doi: 10.1016/j.compbiomed.2025.110398. Epub 2025 May 18.

ABSTRACT

BACKGROUND: Aortic annuloplasty, involving the implantation of an external ring around the aortic root to reduce annular dimensions, is a promising treatment for aortic valve insufficiency. However, its hemodynamic effects remain underexplored due to the absence of computational models validated by experimental and clinical data.

METHODS: This study introduces a computational fluid-structure interaction (FSI) model of supra valvular aortic annuloplasty using 4D-flow magnetic resonance imaging (MRI). Native and post-annuloplasty conditions of idealized aortic root phantoms, including the aortic valve, were CAD-modelled and 3D-printed with elastic resin. These phantoms were tested in a mock circulatory flow-loop providing normal pulsatile physiologic conditions using a glycerol-water mixture to simulate blood viscosity. Flow and pressure data collected from sensors were used as boundary conditions for FSI simulations. Experimental velocity fields from 4D-flow MRI were compared to computational results to assess model accuracy.

RESULTS: MRI scans of the annuloplasty model showed an increased peak systolic velocity (up to 145.4 cm/s) and localized flow alterations, corresponding to a higher pressure gradient across the valve. During regurgitation, the annuloplasty model showed broader velocity distributions compared to the native condition. The FSI simulations closely matched 4D-flow MRI data, with strong correlation coefficients (r > 0.93) and minimal Bland-Altman differences, particularly during systolic phases.

CONCLUSIONS: This study establishes an integrative methodology combining in-vitro, in-silico, and clinical imaging techniques to evaluate aortic annuloplasty hemodynamics. The in-vitro validated digital twin framework offers a pathway for patient-specific modelling, enabling prediction of surgical outcomes and optimization of aortic valve repair strategies.

PMID:40388869 | DOI:10.1016/j.compbiomed.2025.110398